Heart infested by fire and phlegm
Small intestine
Excess
Heat
Heart Qi
Deficiency
Heart and SI
Syndrome
Differentiation
Phlegm
Impaired
Mental
Facilities
Heart
Yang
Deficiency
Heart
Yang
Collapse
Heart
Blood
Deficiency
Heart Vessels
Obstruction
Hyperactivity of Heart Fire
Heart Yin
Deficiency

• Caused by chronic diseases; congenital deficiency; aging; serious disease.
• Clinical manifestations: palpitation; chest distress; short breath; lassitude; spontaneous sweating, pale tongue, white coating and weak pulse.
• Insufficient heart qi leads to palpitation, chest distress , spontaneous sweating and fails to push blood fails to push blood , heart lacks nourishment leads to lassitude, pale tongue with white coating and weak pulse.

Causes
Worsen heart qi deficiency leads to cold limbs and other yang deficiency symptoms
Clinical
Manifestations
Palpitation, chest distress; short breath; spontaneous sweating, aversion to cold, cold limbs, pale complexion and pale and enlarged or purple tongue with white and slippery coating, faint pulse.
Declining heart yang and hypo-function of the heart bring about palpitation
Syndrome
Analysis

Distress and pain in the chest, symptoms of yang exhaustion syndrome
Exhaustion of Yang qi leads to fluid depletion, causing cold sweat and cold limbs; failure of blood nourishing the upper part of the body leads to pale tongue and pale complexion; collapse of yang qi results in severe loss of pectoral qi; deficient heart yang causes retention of cold in the meridians and heart vessel obstruction, stabbing pain the chest, cyanotic lips and purple tongue.
In addition to manifesting heart yang deficiency syndrome, sudden cold sweat, cold limbs, faint breath, pale complexion, or stabbing pain in the chest, cyanotic lips or coma, pale or light purple tongue and weak pulse.

Syndrome Common Points
Heart yang deficiency
Heart qi deficiency
Heart yang collapse
Severe palpitation, chest distress and shortness of breath, worse when active, spontaneous sweating
Different
Points
Aversion to cold and cold limbs, headache, pale complexion
Tongue
Characteristic and Pulse
Condition
Pale and enlarged tongue with white and greasy or dark coating, faint pulse
Pale complexion
Cold sweat, cold limbs, faint breath, pale complexion, cyanotic lips, or coma
Pale tongue with white coating, deficient pulse
Pale or light purple tongue, faint and thin pulse.

• Palpitation or severe palpitation, insomnia and disturbed sleep, dizziness, pale and sallow complexion, pale lips and tongue, weak pulse.
• Insufficient blood, malnutrition and abnormal heart beat caused palpitation;
Failure of blood nourishing the heart results in insomnia and disturbed sleep, dizziness, pale or sallow complexion, pale lips and tongue and weak pulse
• Palpitation, insomnia, disturbed sleep and other symptoms of blood deficiency syndrome

心阴虚证
• Palpitation or severe palpitation, insomnia and disturbed sleep, restlessness, heat in the chest, palms and soles, night sweating, dry mouth and throat, red tongue with scanty saliva, thin and rapid pulse.
• Deficiency of heart yin fails to nourish the heart results in abnormal heart beat and palpitation, disturbed sleep and restlessness; insufficient yin gave rise to deficiency-heat , palms and soles, night sweating, dry mouth and throat, red tongue with scanty saliva and fine rapid pulse.
• Palpitation, insomnia, disturbed sleep and other symptoms of yin deficiency syndrome.

Syndrome Common points Different points Tongue and pulse characteristics
Heart blood deficiency
Heart yin deficiency
Palpitation or severe palpitation, insomnia, disturbed sleep
Amnesia, dizziness, pale white or sallow complexion, pale lips
Heat in the chest, palms, soles, tidal fever, night sweating, flushed cheeks
Pale tongue, weak pulse
Red tongue with scanty saliva, fine and rapid pulse

Restlessness, insomnia, flushed face, thirst, ulcers in the mouth and tongue, red tongue, rapid pulse, or mania with delirium accompanied with yellowish urine and painful urination and hematuria 尿血 .
Internal flaming of heart fire disturbs the mind results in insomnia, mania and delirium. Upward flaming of the fire leads to ulcers in the mouth and tongue and flushed face. Fire also hurts body fluids results in thirst.
When heart fire invades the small intestine, dark urine with painful urination noticed. Injury of blood vessels by fire caused hematuria.
Abnormal mental activities or ulcers in the mouth and tongue, accompanied with symptoms of excess heat syndrome.

Obstruction of Heart Vessels Syndrome
心脉痹阻证
Palpitation or severe palpitation, distress and pain in the chest and shoulder, back and the arm. Obesity patient may manifest profuse phlegm, heavy body, severe dull pain, white and greasy tongue tongue, sunken and slippery pulse caused by heart vessel blocked by phlegm. Cold accumulated in the heart vessel leads to severe pain, alleviated by warmth, aversion to cold and cold limbs, pale tongue with white coating, deep slow or deep tense pulse. Stagnant qi obstructs the heart vessel causes distending
Deficient heart yang fails to warm and nourish the heart induces abnormal heart beat and severe inadequate yang cause blood stasis and phlegm accumulation and obstruct the heart vessel.
Palpitation or severe palpitation, occasional distress and pain in the chest.

Syndrome Common points Different points Tongue and pulse characteristics
Heart vessel blocked by blood stasis
Heart vessel blocked by phlegm
Palpitation or severe palpitation, occasional distress and pain in the chest and shoulder, back and arm could be affected.
Stabbing pain
Severe distress in the chest, obesity with profuse phlegm, heavy body and lassitude
Purple tongue, or with ecchymosis or spots, fine rough or knotted intermittent pulse
White and greasy coating, deep slippery pulse

• Dementia, unsound mind, or depression, selftalking, abnormal behavior; wheezing sputum in the throat, coma, excessive sputum with chest distress, greasy tongue coating and slippery pulse.
• When the mind is blocked by phlegm, abnormal mental activity emerged such as dementia or selftalking or coma.
• Abnormal mental activity, accompanied by symptoms of internal excessive phlegm syndrome.

• Coma, delirium and agitation can be externally contracted where flaming of internal heat leads to constipation and yellow urine.
• Vomiting or coughing of yellow sputum or wheezing in the throat can be caused by internal exuberance of phlegm and fire.
• Behavior indicating personality order such as violent action, laughing and weeping without restraint can be noticed.
• High fever, excessive phlegm, coma or restlessness, insomnia and mania are key points in syndrome differentiation.

Syndrome Common points Different points
Phlegm
Impaired
Mental
Facilities
Heart infested by fire and phlegm
Abnormal mental activities, accompanied by internal excessive phlegm
Depressive psychosis, epilepsy, dementia but absence of fire syndrome
Restlessness, agitation and obvious heat syndrome.
Tongue and pulse characteristics
Greasy tongue coating, slippery pulse
Red tongue with yellow greasy coating, slippery and rapid pulse.

Heart infested by fire and phlegm
Heart Qi
Deficiency
Heart Yang
Deficiency
Phlegm
Impaired Mental
Facilities
Heart
Syndrome
Differentiation
Caused by blood stasis
Caused by phlegm
Obstruction of Heart
Vessels
Caused by
Accumulation of cold
Caused by
Accumulation of qi
Hyperactive
Heart Yang
Heart Yin
Deficiency
Collapse of Heart
Yang
Heart Blood
Deficiency

Restlessness, insomnia, flushed face, dry mouth and throat, dark urine, pain in the urinary duct, hematuria, red tongue with white coating and rapid pulse.
The heart and small intestine are interior-exterior related. Downward movement of heat causes dysfunction of the small intestine and manifestations of heat symptoms.
Dark urine with burning pain and other symptoms of excess heart fire.

Heart infested by fire and phlegm
Small intestine
Excess
Heat
Heart Qi
Deficiency
Heart and SI
Syndrome
Differentiation
Phlegm
Impaired
Mental
Facilities
Heart
Yang
Deficiency
Heart
Yang
Collapse
Heart
Blood
Deficiency
Heart Vessels
Obstruction
Hyperactivity of Heart Fire
Heart Yin
Deficiency

Heart infested by fire and phlegm
Small intestine
Excess
Heat
Heart Qi
Deficiency
Heart and SI
Syndrome
Differentiation
Phlegm
Impaired
Mental
Facilities
Heart
Yang
Deficiency
Heart
Yang
Collapse
Heart
Blood
Deficiency
Heart Vessels
Obstruction
Hyperactivity of Heart Fire
Heart Yin
Deficiency

fluid
Deficiency of the
Large
Intestine
Incessant
Diarrhea caused by
Deficient
Large Intestine
Qi
Lung and
Large
Intestine
Syndrome
Damp-
Heat of the Large
Intestine
Lung Qi
Deficiency
Lung Yin
Deficiency
Wind-Cold
Restraining the Lung
Wind-
Heat
Invading the Lung
Phlegm-
Dampness
Obstructing the Lung
Accumulated
Heat in the
Lung
Dryness
Invading the Lung

Clinical
Manifestations
• Weak coughing and panting, lassitude, weak voice, aversion to cold, pale complexion, spontaneous sweating, pale tongue and deficient pulse.
Syndrome
Analysis
• Insufficient lung qi leads to easy contraction of cough and panting; Weak disperse of lung qi results in aversion to cold and spontaneous sweating; Weak flow of qi and blood fails to nourish the face leads to pale complexion.
Focal Points
• Weak coughing and panting, clear and thin phlegm and other symptoms of qi deficiency.

Dry cough with scanty but sticky sputum, dry mouth and throat, tidal fever, heat in the chest, palms and soles, night sweating, flushed cheeks, sometimes coughing bloody sputum, hoarse voice, red tongue with scanty coating and fine, rapid pulse.
Insufficient lung yin and internal generation of deficiency-heat leads to adverse qi rising and coughing. Body fluids are scorched into sputum and hence scanty sticky sputum.
Failure of Lung yin to rise to moisten the throat and mouth caused dryness, tidal fever and heat symptoms.
Heat attacked the lung vessels induce bloody sputum.
When the throat lacks moistening from yin fluid cause hoarse voice, red tongue with scanty saliva, and fine and rapid pulse.
Dry cough with no or scanty but sticky sputum and other symptoms of yin deficiency syndrome.

Wind-Cold Restraining the Lung syndrome
风寒束肺证
Clinical Manifestations Syndrome Analysis Key Characteristics
White thin and clear sputum, stuffy nose with watery discharge, slight aversion to cold, mild fever, absence of sweating, thin and white tongue coating, floating and tense pulse.
Cold invaded the lung channel restrains lung qi from dispersing; adverse flow of qi results in cough, stuffy nose with watery discharge.
Defensive qi obstructed by wind-cold leads to aversion to cold and tense pulse; confrontation between healthy qi and pathogens induced fire ; absence of sweating is due to obstruction of follicular orifices.
Coughing, panting, white and thin sputum, and other symptoms of the wind-cold exterior syndrome.

• Coughing thick yellow sputum, stuffy nose with yellow and turbid discharge, fever, mild aversion to wind-cold, dry mouth and sore throat, red tongue tip, thin yellow tongue coating and floating rapid pulse.
• Wind-heat invaded the lung causing failure of lung qi to disperse and descend and results in thick yellow sputum, sore throat and stuffy nose; disorders of defensive qi leads to fever and aversion to wind-heat;
• Cough, thick yellow sputum and other symptoms of wind-heat.

• Expectoration of thick and yellow sputum, heavy breath, high fever, or flaring of nares or chest pain, expectoration of bloody pus and fishy smell sputum, dry stools, dark urine, red tongue with white coating, and slippery rapid pulse.
• Fever, cough and heavy breath are due to exuberance of lung heat and dysfunction of ling qi in dispersion and descent. Chest pain and flaring of nares, spitting of fishy smell sputum are due to burning lung heat.
• Cough, excessive sputum and other symptoms of interior excess heat syndrome.

Dryness invasion of the lung results in deficient body fluids, fever and aversion to cold; lung lacks moistening and lung qi fails to descend and disperse caused dry cough and little but sticky sputum and difficult to expectorate; chest pain and hemoptysis are due to fire in the lung vessels. Injury to body fluids by dry-heat results in rapid pulse. Floating rapid pulse is seen in the exterior syndrome
Dry cough, scanty sputum and other symptoms of dryness with scanty body fluids.
Dry cough, with a little but sticky sputum or having difficulty to expectorate; dry lips, tongue, mouth, nose, throat and skin, or fever with aversion to cold, or chest pain, dry tongue with thin coating and rapid pulse

Syndrome Main
Wind-heat invading the lung symptoms
Cough with thick and yellow sputum
Accumulat ion of heat in the lung
Cough, panting, yellow sputum
Dryness invading the lung
Dry cough with a little but sticky sputum or no sputum
Other symptoms Tongue characteristics
Stuffy nose with yellow and turbid discharge, fever, aversion to wind, dry mouth and sore throat
Red tongue tip, with thin and yellow tongue coating
Thirst, restlessness, flaring of nares, nosebleed or hemoptysis, chest pain, expectoration of bloody pus and fishy smell sputum
Red tongue with yellow coating
Dry mouth, tongue, throat and skin, scanty sweating
Dry tongue with thin coating, scanty saliva
Pulse condition
Floating rapid pulse
Slippery rapid pulse
Rapid pulse

• Cough, excessive sticky and easy to expectorate white sputum, chest distress, panting and wheezing in severe case, pale tongue with white greasy coating and slippery pulse.
• Phlegm-dampness obstructs the lung leading to dysfunction in dispersion and descent, manifesting coughing and excessive sticky and white phlegm.
Obstruction of the air passage by phlegm-dampness and stagnation of qi leads to chest distress, panting and wheezing in severe case.
• Cough, profuse, sticky and easy to expectorate white sputum and white greasy tongue coating.

Abdominal pain, red and whitish stools in diarrhea, severe diarrhea with yellow and fetid stools, accompanied by burning feeling around the anus, dark urine, thirst, or aversion to cold, fever without chills, red tongue with yellow greasy coating, soggy rapid or slippery and rapid pulse.
Damp-heat invasion of the large intestine obstructs movement of qi causing abdominal pain; when damp-heat fumigates the intestinal tract caused sticky blood stools or yellow and watery stools. When the intestinal tract is attacked, burning heat occurs around the anus. Dark urine due to water loss in diarrhea. Fever and aversion to cold can be seen with exterior syndrome. When heat remains inside, there is fever without chills. Red tongue with yellow greasy coating points to damp-heat.
Abdominal pain, dysentery, symptoms of diarrhea ad other symptoms of the damp-heat syndrome

• Constipation, dizziness, foul breath, read tongue with scanty saliva, dry yellow tongue coating and rough pulse.
Clinical manifestations
Syndrome
Analysis
• Insufficient fluid in the large intestine fails to moisten the intestinal tract resulting constipation, rough pulse and yellow dry tongue coating with scanty saliva; obstructed qi of the large intestine disturbs the stomach qi from descending causing foul breath and dizziness;
• Constipation, and other symptoms of insufficient body fluid.
Focal Points

Incessant Diarrhea Associated With Deficient
Large Intestine Qi Syndrome
Clinical Manifestations
Syndrome Analysis
Chronic and incessant diarrhea, dull abdominal pain, alleviated by heat or pressure, pale tongue with white slippery coating and weak pulse.
Incessant diarrhea exhaust yang qi and caused fecal incontinence; Yang qi deficiency in the large intestine leads to cold coagulation and qi stagnation and dull abdominal pain, pale tongue with white slippery coating and weak pulse.
Focal points
Fecal incontinence and other symptoms of deficiency-cold .

fluid
Deficiency of the
Large
Intestine
Incessant
Diarrhea caused by
Deficient
Large Intestine
Qi
Lung and
Large
Intestine
Syndrome
Damp-
Heat of the Large
Intestine
Lung Qi
Deficiency
Lung Yin
Deficiency
Wind-Cold
Restraining the Lung
Wind-
Heat
Invading the Lung
Phlegm-
Dampness
Obstructing the Lung
Accumulated
Heat in the
Lung
Dryness
Invading the Lung

Cold
Stagnating in Stomach
寒滞胃脘
Food
Retention in Stomach
食积胃脘
Intense
Stomach
Fire 胃火炽
盛
Spleen Qi
Deficiency
脾气虚
Spleen &
Stomach
Disease
Syndrome
Differentiation
Spleen
Yang
Deficiency
脾阳虚
Spleen
Deficiency and Sinking of Qi 脾虚气
陷
Failure of the Spleen to Control
Blood 脾不
统血
Stomach
Yin
Deficienc y
胃阴虚
Stomach
Yang
Deficiency
胃阳虚
Stomach
Qi
Deficiency
胃气虚
Damp-Heat
Accumulating in the Spleen
湿热蕴脾
Colddampness
Accumulating in the Spleen
寒湿困脾

Clinical manfestations
• Abdominal distension, poor appetite, aggravated after eating, loose stools, lassitude, shortness of breath, dislike talking, sallow complexion, or obesity, or edema, pale tongue with white coating, or pale and enlarged tongue with tooth mark, slow and weak pulse.
Syndrome
Analysis
• Insufficient spleen qi leads to poor digestion of the stomach marked by abdominal distension, poor appetite, water retention, loose stools; insufficient qi brings about lassitude, dislike to talk, sallow complexion, pale tongue, slow and weak pulse. Enlarged tongue with tooth-mark, edema caused by water and phlegm-fluid accumulation.
• Poor appetite, abdominal distension, loose stools and other symptoms of qi deficiency syndrome.

• Abdominal distension and pain, alleviated by warmth and pressure, poor appetite, loose stools or stools with undigested food stuff, aversion to cold and cold limbs, tastelessness, not thirsty, or edema, or large volume of clear urine, pale and enlarged tongue with tooth mark, white slippery or white greasy coating and deep, slow weak pulse.
• Weak spleen yang generates cold results in abdominal distension, poor appetite and loose stools; when water flows over the skin edema occur and large volume of urine when it flows downward;
Yang deficiency and internal accumulation of cold-dampness caused enlarged tongue with tooth mark, white slippery or white greasy tongue coating, deep slow and weak pulse.
• Cold pain in the abdomen, alleviated by heat and pressure, abdominal distension, loose stools and other symptoms of deficiency-cold.

• Feeling of distension in the stomach and abdomen, aggravated after eating; drooping and distension in the anus, persistent diarrhea, lassitude, dizziness, poor appetite, loose stools, pale tongue with white
coating and weak pulse.
• Deficient spleen qi leads to sinking of middle qi and prolapse of stomach, rectum and uterus; failure of distributing usable substances leads to turbid urine; failure of rising spleen yang caused dizziness, lassitude, reluctant to talk, pale tongue and weak pulse.
• Sense of drooping in the abdomen and stomach, persisted diarrhea or prolapse of internal organs and other symptoms of spleen qi deficiency.

• Muscular bleeding, gum bleeding, nosebleed, or accompanied by poor appetite, abdominal distension, loose stools, pale or sallow complexion, lassitude, dislike talking, pale tongue with white coating and weak pulse.
• Blood leaking out of the vessels and failure of spleen qi to govern blood caused bleeding in the stomach, intestine, urinary bladder, skin and orifices; poor appetite and loose stools result from disturbed transportation of spleen qi.
• Chronic hemorrhage and other symptoms of spleen qi deficiency.

Syndrome Common Points Different Points Tongue and Pulse
Characteristics
Deficiency of
Spleen Qi
Deficiency of
Spleen Yang
Abdominal distension, poor appetite, aggravated after eating, loose stools, lassitude, shortness of breath, reluctant to talk, sallow complexion
Obesity or edema Pale tongue with white coating, moderate and weak pulse
Abdominal cold pain and distension, loose stools or stools with undigested food stuff, aversion to cold and cold limbs, or edema of large volume of urine
Pale and enlarged tongue with tooth mark, white slippery or white greasy coating, deep, slow and weak pulse.

Syndrome
Spleen Deficiency and Sinking of
Spleen Qi
Common Points
Abdominal distension, poor appetite, aggravated after eating, loose stools, lassitude, shortness of breath, reluctant to talk, sallow complexion
Different Points
Sense of drooping and distension in the stomach, abdomen and anus, or persisted diarrhea, rectal prolapse, or turbid urine, dizziness
Tongue and Pulse
Characteristics
Pale tongue with white coating, weak pulse
Deficiency of
Spleen fails to control outflow of blood
Excessive menorrhea, nosebleed, gum bleeding and muscular bleeding.
Pale tongue with white coating, weak pulse.

Distress and pain in the abdomen and stomach, anorexia, loose stools, nausea, tastelessness, no desire to drink water, heavy head and body, or edema, or yellow eyes, sallow complexion, enlarged tongue, white greasy or white slippery coating soggy and slow pulse
Accumulation of Cold-Dampness causing dysfunction of the spleen and stomach in transporting, transforming, ascending and descending and unsmooth qi flow, marked by distress and pain in the abdomen and stomach, anorexia, loose stools and nausea.
Cold-dampness obstructs yang, leading to heaviness in the head and body. Yellow eys and sallow complexion due to overflow of bile. Enlarged tongue , white greasy or white slippery coating, soggy and slow pulse indicate accumulation of cold-dampness
Distress and pain in the abdomen and stomach, anorexia, loose stools nausea and other symptoms of internal accumulation of colddampness.

Distress and pain in the abdomen and stomach, anorexia, nausea, loose and sticky stools, heaviness in the head and body, thirsty, no desire for drinks, mild fever, or bright yellow skin and eyes, red tongue with yellow greasy coating and soggy rapid pulse .
Accumulation of damp-heat leads to dysfunction of the spleen and stomach in receiving, transporting, ascending and descending, marked by distress and pain in the abdomen and stomach, anorexia and nausea. Damp-heat invaded the large intestine results in loose and sticky stools; dampness accumulated in the body caused heaviness in the head and body and thirsty but no desire for drinks and mild fever. Bright yellow skin and eys are caused by leak of bile. Red tongue with yellow greasy coating, soggy rapid pulse all indicate internal accumulation of damp-heat.
Distress and pain in the abdomen and stomach, anorexia, nausea, and other symptoms of internal accumulatio n of damphea t.

Syndrome
Accumulation of
Damp-heat in the
Spleen
Accumulation of
Cold-Dampness in the Spleen
Common Points Different Points
Distress and pain in the abdomen and stomach, anorexia, nausea, loose and sticky stools, heaviness in the head and body, yellow face and eyes
Mild fever, thirst, no desire for drinks
, loose stools , scanty urine.
Abdominal pain, alleviated by warmth, tastelessness, no desire for drinks, loose stools, large volume of urine or edema.
Tongue and Pulse
Characteristics
Red tongue with yellow greasy coating, soggy rapid pulse.
Enlarged tongue, white greasy or white slippery coating, soggy slow pulse.

• Fullness and distension in the stomach, aggravated after eating, belching or dull pain in the stomach, lassitude, dim complexion, thin white tongue coating, and weak pulse.
• Deficient stomach qi leads to poor digestion and fullness and pain in the stomach; Unsmooth flow of stomach qi leads to poor appetite and belching; Qi deficiency results in lassitude, dim complexion, thin white tongue coating and weak and deficient pulse.
• Fullness and pain in the stomach, poor appetite, belching and other symptoms of qi deficiency.

Gastric discomfort and acid regurgitation, no desire to eat, or fullness in the stomach with dull pain, nausea, hiccup, dry mouth and throat, dry stools, red tongue with scanty coating and saliva and thready rapid pulse.
Insufficient stomach qi generated internal deficiency-heat leads to gastric discomfort and acid regurgitation and no desire to eat; nausea and hiccup are caused by reversed ascending of stomach qi; dry mouth and throat caused by yin deficiency; intestinal tract lacks moistening resulting dry stools; red tongue with scanty coating and saliva, thready and rapid pulse indicate internal exuberance of heat and yin deficiency.
Gastric discomfort, acid regurgitation burning pain, no desire to eat and other symptoms of deficiency-heat.

Clinical Manifestations
Abnormal increased appetite with frequent hunger, gastric discomfort, acid regurgitation, or burning pain in the stomach, or foul breath, swollen gum bleeding, desire for cold drinks, constipation, yellow urine, red tongue with yellow coating, slippery and rapid pulse.
Syndrome Analysis
Exuberance of stomach fire leads to hyperactivity of digestion, and abnormal increased appetite with frequent hunger. Burning pain in the stomach due to stomach qi failing to descend. Four breath, swollen gum bleeding are caused by vessels scorched by stomach fire. Flaming of fire impairs body fluids, resulting in thirst with a desire for cold drinks, constipation and yellow urine.
Focal Points
Gastric discomfort, acid regurgitation, burning pain in the stomach, swollen gum bleeding and other symptoms of internal flaming of fire.

Clinical Manifestations
Acute cold pain in the stomach, worse when exposed to cold, better when exposed to heat, hiccup or belching, tastelessness in the mouth, thirsty or vomiting clear water, cold body and limbs, white moist coating, deep and tense or wiry pulse.
Syndrome Analysis
Cold evil invaded the stomach impeded qi flow and leads to acute cold pain in the stomach.
Adverse rise of stomach qi results in hiccup or belching, tastelessness in the mouth, thirsty, or vomiting clear water result from stomach yang qi injured by cold. Cold body and limbs, white moist tongue coating, and deep tense or wiry pulse indicate internal exuberance of cold.
Focal Points
Severe cold pain in the stomach, and other symptoms of the excess cold syndrome.

Clinical Manifestations
Fullness in the stomach and abdomen, or distending pain, anorexia, fetid eructation, or vomiting undigested food stuff, relieved after vomiting, fetid stools, thick greasy tongue coating and slippery pulse.
Syndrome Analysis Focal Point
Food retention in the stomach obstructs qi flow, leading to fullness in the stomach and abdomen, or distending pain and anorexia. Undigested food causes reversed rise of qi in the stomach, resulting in fetid eructation, thick and greasy tongue coating.
Fetid stools are due to dysfunction of the large intestine.
Fullness in the stomach and abdomen, distending pain, anorexia and fetid eructation.

Food
Retention in
Stomach
Spleen Qi
Deficiency
Spleen
Yang
Deficiency
Cold
Stagnating in Stomach
Spleen
Deficiency and
Sinking of
Qi
Intense
Stomach
Fire
Stomach
Yin
Deficiency
Stomach
Yang
Deficiency
Spleen &
Stomach
Disease
Syndrome
Differentiation
Stomach
Qi
Deficiency
Failure of the
Spleen to
Control
Blood
Damp-
Heat
Accumula ting in the
Spleen
Colddampness
Accumula ting in the
Spleen

Liver
Blood
Deficiency Gallbladder
Qi
Obstruction with Phlegm disturbance
Liver Yin
Deficiency
Cold
Stagnating in the Liver
Meridian
Liver-Gallbladder
Disease
Syndrome
Differentiation
Liver
Yang
Transfor ming into
Wind
Liver &
Gallbladder
Damp-Heat
Extreme Heat
Generate Wind
Blood
Deficiency
Generate Wind
Stirring of
Liver Wind
Hyperactivity of Liver Yang
Liver Qi
Stagnation
Blazing of
Liver Fire

• Dizziness, pale complexion, blurred vision or night blindness, pale nails, numbness of limbs, convulsion, joint motion problem, scanty menses with light color, pale tongue with white coating and fine pulse.
• Insufficient liver blood caused dizziness, pale complexion, scanty menses and so on. Internal stirring of wind leads to limb numbness, convulsion, joint motion problem.

• Dizziness, dry eyes, visual problem dull burning pain in the hypochondrium, or convulsion, hot face , heat in the chest, palms and soles, tidal fever, night sweating, dry mouth and throat, red tongue with scanty saliva and fine rapid pulse.
• Failure of insufficient liver yin to moisten the head and eyes leads to dizziness, dry eyes. Malnutrition of the liver and internal deficiency –fire causes dull burning pain in the hypochondrium. Internal stirring of deficiency-wind leads to malnutrition of the tendons and vessels. Hot face, heat in the chest, palms and soles, tidal fever, night sweat, dry mouth are manifestations of yin deficiency.

• Distending pain in the chest or breasts, depressed or irritable, frequent sighing, thin white coating, wiry pulse, irregular menses,.
• Dysfunction and obstruction of liver qi results in distending pain in the chest, irritable or depressed. Thin white coating and wiry pulse indicate liver qi stagnation.

• Dizziness with distending pain in the head, flushed face and bloodshot eyes, irritable, bitter taste and dry mouth, yellow urine, dry stools, red tongue with yellow dry coating, wiry rapid pulse, or sudden tinnitus and deafness, insomnia, dream-disturbed sleep, or spitting blood and nosebleed.
• Blazing of liver fire attack the head and eyes; liver fire hurts body fluids causes bitter taste and dryness in the mouth; interior fire causes insomnia; when liver heat enters the ear results in sudden tinnitus and deafness; spitting blood and nosebleed are due abnormal flow of blood.

• Dizziness, tinnitus, distending pain in the head and eyes, flushed face and bloodshot eyes, irritable, insomnia and dream-disturbed sleeps weakness in the lower back and knees, heavy head and frail feet, red tongue with scanty saliva, wiry powerful rapid pulse.
• Upward disturbance of liver yang.

1. Liver Yang Transforming into Wind Syndrome
肝阳化风证 :
Dizziness, involuntary head twitching and pain, numbness and tremor, unsteady walking or conscious with partial facial paralysis , or sudden loss of consciousness, red tongue with greasy or yellow greasy coating and wiry powerful pulse.
Hyperactive liver transformed into wind causing qi and blood to flow upward leads to dizziness, involuntary head twitching and unsteady walking.

2. Extreme Heat Generate Wind Syndrome: 热极
生风证
High fever, convulsion, stiff neck, upward rolling of eyes, lockjaw, or coma and delirium, dark-red tongue with white dry coating and wiry rapid pulse.
Liver channel scorched by blazing fire. When fire disturbs the mind results in restlessness coma and delirium.

3. Blood Deficiency Generate Wind Syndrome 血
虚生风证 :
Numbness and tremor of limbs, muscular spasm, dysfunction of joints, dizziness, tinnitus, pale complexion, nails and tongue and fine pulse.
Insufficient liver blood caused the above symptoms.

4. Yin Deficiency Stirring Wind Syndrome 阴虚动
风证 :
Tremor of limbs, dizziness, tinnitus, tidal fever, night sweat, flushed cheeks, dry throat, red tongue with scanty coating and rapid pulse.
Failure of insufficient liver yin to moisten the head and eyes leads to dizziness, dry eyes.

Liver and Gallbladder Damp-Heat Syndrome
肝胆湿热证
• Intense heat and distending pain in the chest, anorexia, abdominal distension, nausea, bitter taste in the mouth, or vomiting yellow-green bitter fluid, constipation, dark urine, red tongue with yellow greasy coating, wiry rapid pulse, or alternate chills and fever, yellow skin and eyes, or eczema of scrotum.

Cold Stagnating in the Liver Channel Syndrome
寒滞肝脉证
• Cold pain in the lower abdomen with the genitals involved, or pain in the scrotum during contracture, or cold pain on the top of head, aggravated by cold and alleviated by warmth, cold limbs, while moist tongue and deep wiry pulse.
• The Liver Meridian surrounds the genitals.
When cold accumulates the Liver Meridian, unsmooth flow of qi and blood occurred.

Gallbladder Qi Obstruction with Phlegm
Disturbance Syndrome
胆郁痰扰证
• Fear, palpitation, restlessness, insomnia and dreamdisturbed sleep, dizziness, tinnitus, distress and suffocation in the chest , bitter taste in the mouth, red tongue with yellow greasy coating and wiry rapid pulse.
• Internal phlegm-heat disturbs gallbladder qi results in fear and palpitation, restlessness, insomnia, dreamdisturbed sleep. Failure of gallbladder’s dispersion results in unsmooth qi flow, distress and suffocation in the chest, bitter taste in the mouth and nausea reversed rise of stomach qi from gallbladder heat.

Liver
Blood
Deficiency Gallbladder
Qi
Obstruction with Phlegm disturbance
Liver Yin
Deficiency
Cold
Stagnating in the Liver
Meridian
Liver-Gallbladder
Disease
Syndrome
Differentiation
Liver
Yang
Transfor ming into
Wind
Liver &
Gallbladder
Damp-Heat
Extreme Heat
Generate Wind
Blood
Deficiency
Generate Wind
Stirring of
Liver Wind
Hyperactivity of Liver Yang
Liver Qi
Stagnation
Blazing of
Liver Fire

Kidney
Yang
Deficiency
Bladder
Damp-
Heat Kidney-Urinary
Bladder Disease
Syndrome
Differentiation
Kidney Yin
Deficiency
Loose
Kidney
Essence
Insufficient
Kidney
Essence

• Weakness and pain in the lower back and knees, cold limbs, sallow complexion, lassitude, low sexual desire, impotence, cold sperms, cold uterus, or chronic diarrhea with undigested food stuff, or diarrhea before dawn, frequent urination and edema, accompanied by palpitation and shortness of breath, wheezing, enlarge pale tongue with tooth mark, white slippery coating, deep weak pulse.
• Failure of kidney yang to warm the body.

• Dizziness, tinnitus, weakness and pain in the lower back and knees, insomnia and dreamdisturbed sleep, hyper-sexuality, nocturnal emission 梦遗泄精 ,metrorrhagia and metrostaxis
崩漏 , flushed cheeks, heat in the chest, palms and soles, tidal fever and night sweat, dry mouth and throat, red tongue with scanty saliva and fine rapid pulse.
• Internal generation of deficiency-heat.

• Retarded development of children, feeble bones, mental retardation, infertility, poor sexual function, hair loss and loose teeth, tinnitus or deafnessand weak feet.
• Decreased function in growth, development and reproduction because of kidney essence deficiency.

• Pale complexion ， lassitude, hearing problem, weakness in the lower back and knees, frequent urination, or urine incontinence, or continuous urine dribbling after urination, or miscarriage, pale tongue with white coating and weak pulse.
• Insufficient or deficient kidney qi.

Syndrome
Kidney yang deficiency
Similar
Manifestati ons
Weakness in the lower back and knees
Different Manifestations
Cold body and limbs, impotence, cold sperms, cold uterus or diarrhea before dawn.
Tongue and Pulse
Characteristics
Enlarged pale tongue, white slippery coating, weak pulse.
Kidney yin deficiency
Insufficient kidney essence
Loose kidney qi
Dizziness, tinnitus, insomnia and dream-disturbed sleep, hyper sexual desire, night sweat, dry mouth and throat.
Red tongue with scanty saliva, fine and rapid pulse.
Retarded growth, feeble bones in children, hair loss, loose teeth, deafness, weak feet.
Pale tongue with white coating, weak pulse.
Hearing problem, frequent urination, incontinence of urine, or dribbling after urination, miscarriage
Pale tongue with white coating, weak pulse.

• Frequent urination, burning pain on urination, bloated lower abdomen, or urinary stone, or accompanied by fever and lower back pain, red tongue with yellow and greasy coating and rapid pulse.
• Bladder attacked and disturbed by heat.

Kidney
Yang
Deficiency
Bladder
Damp-
Heat Kidney-Urinary
Bladder Disease
Syndrome
Differentiation
Kidney Yin
Deficiency
Loose
Kidney
Essence
Insufficient
Kidney
Essence

• Restlessness, insomnia, palpitation, dreamdisturbed sleep, dizziness, tinnitus, amnesia, weakness in the lower back and knees, heat in the chest, palms and soles, tidal fever, night sweat, dry mouth and throat, red tongue with scanty coating and fine and rapid pulse.

• Palpitation, insomnia, dream-disturbed sleep, dizziness, pale and sallow complexion, dry eyes, blurred vision, pale nails, numbness or tremor of limbs, scanty menstruation with thin and light-color menses, pale tongue with white coating and fine pulse.

• Cold body and limbs, palpitation or severe palpitation, difficulty in urination, cyanosed lips and nails, pale purple tongue with white and slippery coating and faint pulse.

Heart-
Spleen
Deficiency
Heart-Kidney disharmony
Heart & Other
Organs
Simultaneously ill
Heart-
Liver
Blood
Deficiency
Heart-
Kidney
Yang
Deficiency

• Palpitation, short breath, coughing and panting, chest distress, vomiting of clear and thin sputum, pale complexion, lassitude, dislike to talk, spontaneous sweating, pale tongue with white coating and weak pulse.

• Anorexia, fullness in the abdomen, loose stools, chronic cough, vomiting of clear and thin sputum, sallow complexion, lassitude, short breath, dislike talking, or edema in the face and limbs, pale tongue with white coating and weak pulse.

• Cold body and limbs, sallow complexion, cold pain in the lower back, knees and lower abdomen, chronic diarrhea, or diarrhea before dawn, stools with undigested food stuff, or edema in the face and limbs, difficulty in urination, pale and enlarged tongue with white slippery coating and deep pulse.

• Cough with scanty sputum, bloody sputum, or hoarse voice, tidal fever, flushed cheeks, night sweat, dry mouth and throat, scanty menses, red tongue with scanty coating and fine rapid pulse.

• Weak coughing and panting, need to take deep breath, profuse and thin sputum, weakness in the lower back and knees, or urine out on coughing, lassitude, feeble voice, short breath, spontaneous sweating, pale tongue with weak pulse.

• Dizziness, tinnitus, weakness in the lower back and knees, dry mouth and throat, insomnia, dream-disturbed sleep, heat in the chest, palms and soles, flushed cheeks, night sweat, scanty menses, red tongue with scanty coating and rapid fine pulse.

• Scurrying and distending pain in the chest and hypochondrium, sigh frequently, depressed or irritable, anorexia, fullness in the abdomen, loose stools, alleviated after diarrhea, pale red tongue with white coating and wiry pulse.

• Dull scurrying and distending pain in the chest and stomach, belching, hiccup, gastric discomfort and acid regurgitation, depressed or irritable, red pale tongue with thin white coating, wiry pulse, or red tongue with yellow coating and wiry rapid pulse.

• Burning pain in the chest, dizziness with distending pain in the head, irritable, bloodshot eyes, bitter taste in the mouth, red tongue with yellow dry coating, and wiry rapid pulse.

• Put forward by Zhang Zhongjing 张仲景 , the famous physician of the Eastern Han dynasty
in Shang Han Za Bing Lun.
• The syndromes present in the course of an externally contracted disease are divided into
Taiyang disease syndrome, Shaoyang disease syndrome, Yangming disease syndrome, Taiyin disease syndrome, Shaoyin disease syndrome and Jueyin disease syndrome.

• Taiyang channel 太阳病证
• Shaoyang channel 少阳病证
• Yangming channel 阳明病证
• Taiyin channel 太阴病证
• Shaoyin channel 少阴病证
• Jueyin channel 厥阴病证
• The three yang channels take the pathological changes of the six fu organs as their basis, characterized by the excess condition;
• The three yin channels take the pathological changes of the five zang organs as their basis, characterized by the deficiency condition or interlocking of deficiency and excess

太阳病证
• Exogenous pathogens usually attack the human body through the Taiyang channels and the healthy qi of the body rises against them in the superficial part of the body.
• Taiyang disease appears with such symptoms as rigidity and pain in the neck, fever, aversion to cold and floating pulse.
• Taiyang disease can be divided into the Taiyang wind-induced syndrome and Taiyang coldinduced syndrome

• Fever, aversion to wind, rigidity and pain in the neck, spontaneous sweating, floating and moderate pulse.

• Excessive heat throughout the body in the exterior and interior.

• Fever, aversion to cold, rigidity and pain in the neck and joints, absence of sweating, floating and tight pulse.

阳明病证
• It is an interior excess heat syndrome with excessive heat in the Yangming channels and heat accumulation in the intestines and stomach.
• It can be divided into two categories: the
Yangming Channel Syndrome and Yangming
Fu-organ Syndrome

阳明经在
• Characterized by excessive heat throughout the body in the exterior and interior.
• High fever, profuse sweating, extreme thirst, flushed face, restlessness, yellow, dry tongue coating and surging pulse.

阳明腑证
• High fever in the afternoon, sweating in the hands and feet, abdominal pain and distension, constipation, irritable, delirium, red tongue with yellow dry coating or dark yellow cracked coating and deep, forceful pulse.

• Alternate cold and fever, fullness in the chest region, loss of appetite, restlessness, vomiting, bitter taste in the mouth dry throat, vertigo and wiry pulse.

太阴病证
• Fullness in the abdomen, vomiting, poor appetite, diarrhea, not feeling thirsty, abdominal pain, pale tongue with white, greasy coating and moderate and weak pulse.

• It is a deficiency syndrome due to hypofunction of the heart and kidney.
• Cold and heat can be found in a Shaoyin disease.

• Chills, huddling up, lassitude, cold limbs, diarrhea with undigested food stuff, vomiting and anorexia , pale tongue with white coating and deep, thin and faint pulse.

• Restlessness, insomnia, dry mouth and throat, red tongue with scanty coating, thin and deep pulse.

• Persistent thirst, chest pain with a sensation of heat, hunger with poor appetite, vomiting roundworms and red tongue will scanty coating.

• Combined Syndromes 合病 – simultaneous diseases syndromes of two or three channels e.g. combined syndromes of Taiyang and
Yangming, Taiyang and Shaoyang and etc.
• Interlapping of Syndromes 并病 – syndromes of two channels appearing in sequence, e.g. interlapping of Taiyang and Shaoyang, Taiyang and Yangming.

• Channel Transmission 传经 -One channel syndrome transmitting to another one.
• Direct Attack 直中 – attack of external pathogens directly to the three yin channels instead of transmission from yang channels caused by insufficient healthy qi which fails to fight against pathogens.

• It is a method of syndrome differentiation for warm diseases, established by Ye Tianshi, 叶天士 a physician specialized in warm diseases of the
Qing dynasty, on the basis of Huangdi Nei Jing ，
Huangdi Classic of Inner Medicine, 黄帝内经 and
Shang Han Za Bing Lun, Treatise on Cold
Pathogenic and Miscellaneous Diseases, 伤寒杂
病论 .
• Its establishment supplements the six-channel syndrome differentiation theory.

• According to it, warm diseases can be divided into four stages:
• The defense system syndrome 卫分证 ; qi system syndrome
气分证 , nutrient system syndrome 营分证 and blood system syndrome 血分证 .
• The first two system syndromes indicate the early and middle stages of a warm disease, in which there is a violent conflict between the strong healthy qi and pathogenic factors.
• The latter two system syndromes indicate the middle and late stages when the healthy qi is injured to some extent and pathogenic factors overwhelm the healthy qi.

• It refers to the syndrome of the initial stage of a warm disease when warm-heat invades the defense system.
• Fever, slight aversion to wind-cold, headache, coughing, slight thirst, sore swollen throat, red tongue edge, and floating and rapid pulse.

• Fever, thirst, sweating, red tongue with yellow coating and rapid pulse, or high fever, profuse sweating, thirst and preference for cold drinks and surging pulse, or restlessness; or coughing and panting, sensation of oppression in the chest or chest pain, coughing of yellow and thick sputum, or diarrhea with yellow and foul feces, burning sensation of the anus.

• It refers to the syndrome caused by deep invasion of the heat pathogen which injures yin and disturbs the mind. There are three routes for the heat pathogen to enter the nutrient system:
- Inward transmission from the qi system;
- Penetration into the nutrient system from the defense system, not via the qi system;
- Direct penetration into the nutrient system without involving the defense system and qi system.

• It is a critical condition of a warm disease.
• There is consumption of yin as well as rampancy of heat.
• It is a syndrome of interlocking of deficiency and excess or it is an excess syndrome.
• It is characterized by injury to yin and disturbance of the mind.
• Fever, restlessness, dry mouth and throat with moderate thirst, or delirium crimson tongue and rapid pulse.

• It is either orderly transmitted from the nutrient system or directly from the qi system without the nutrient system.
• It is a critical condition of a warm disease, which is induced by exuberance of the pathogenic factors or deficiency of the healthy qi of no treatment and improper treatment.
• The heat pathogen invades the blood system and injures the zang and fu organs, channels, characterized by bleeding and stirring-up of wind and injury to yin.

• Fever, worse at night, restlessness, dense skin eruption, delirium, hematemesis 吐血 , epistaxis 流鼻血 , hematuria 尿血 , hemafecia 便
血 , crimson tongue and rapid pulse, or rigidity in the neck and back, convulsion, or persistent low fever, heat in the palms, soles and chest, tinnitus and deafness, red tongue with scanty saliva and deficient and rapid pulse.

• Normal Transmission- it means transmission of a disease in the normal sequence, i.e. from the superficial part to the interior, from shallow to deep and from mild to serious.
• This pattern follows the transmission order of the defense-qi-nutrient-blood systems.
• It suggests a relatively simple and mild disease.

• Abnormal Transmission – it means transmission of a disease not in the normal sequence e.g. from the defense system directly to the nutrient system and blood system instead by the way of qi system.
• It indicates a critical condition.
• There are three causes: the over-abundance of pathogenic factors, deficiency of the healthy qi and no treatment and improper treatment.

• It is a method of syndrome differentiation for warm diseases put forward by Wu Jutong 吴鞠通 , a specialist of warm diseases of the Qing dynasty in
Wen Bing Tiao Bian 温病条辨 (Analysis of Warm
Diseases)
• In this system, the syndromes of externally contracted warm diseases are classified into three types: the upper-energizer syndrome, middleenergizer syndrome and lower-energizer syndrome to illustrate the pathological changes, manifestations and the transmission rule to guide treatment.

• It is caused by warm-heat attacking the Lung
Channel of Hand-Taiyin and Pericardium Channel of Hand-Jueyin.
• Fever, slight aversion of wind and cold, coughing, sweating, thirst, headache, red tongue edge, floating and rapid pulse, or fever without aversion to cold, coughing, panting, sweating, thirst, yellow coating and rapid pulse; or high fever, delirium, rigid tongue, cold limbs and crimson tongue.

• It refers to the pathological changes caused by the heat pathogen entering the spleen from the upper-energizer, marked by the dryness and dampness syndromes.
• They may transform into the dry-heat syndrome and damp-heat syndrome, known as the Yangming dryness syndrome and Taiyin damp-heat syndrome.

• Fever, flushed cheeks, harsh breathing, abdominal fullness, constipation, thirst and preference for cold drinks, dry mouth and cracked lips, dark urine, red tongue with yellow dry coating or dark yellow coating with prickles, deep excess and forceful pulse, heavy sensation of the body, suffocating feeling in the gastric region, nausea, difficult defecation or loose stools, red tongue with yellow greasy coating, and soggy and rapid pulse.

• It is the late stage of warm diseases in which the heat pathogen invades the lowerenergizer and injures liver yin and kidney yin.
• Fever, flushed cheeks, feverish sensation in hands and feet, more serious in palms and soles, dry mouth and throat, lassitude, deafness or poor hearing, crimson tongue with scanty coating and deficient pulse.

• Start from the Lung Channel of Hand-Taiyin to the middle-energizer and lower-energizer.
• It is a pathological process from the upper to lower, from superficial to deep, and from mild to severe, called normal transmission.
• When they are too strong and the healthy qi is weak, the pathogenic factors invade the
Pericardium Channel of Hand-Jueyin from the defense system.

• Transmission from the upper to lower is a common rule.
• When pathogenic factors attack the upperenergizer and they are eliminated soon, so there is no transmission; or the syndrome of the middle-energizer occurs when the syndrome of the upper-energizer remains;
• Or the pathogenic factors transmit directly into the lower-energizer from the upper-energizer;

• Or the syndrome of the lower-energizer appears when that of the middle –energizer remains;
• Or disorder occurs in the middle-energizer of the lower-energizer;
• Or interlocking of syndromes are found in the upper-energizer and middle-energizer.
• An overall analysis of the clinical data is needed to decide the condition of the syndromes of the triple energizer.